Friday, January 31, 2014

Tales from the schizophrenia ward - Part V: Therapy?

Anyone who voluntarily enters inpatient life goes into a clinic with the expectation that he will receive help with his/her mental issues through therapy. Some of the veterans might go only for changing their medication, but to those who are new to the routine, medication is either perceived as a necessary crutch to support actual therapy, or entirely unnecessary while therapy does the actual work. Well, I can only speak from my experience, and from the experience of the many people I have met during my three tenures as an inpatient, but frankly, therapy is a load of crap.

First off, you know how politicians always whine about how the government is out of money? Yeah, that's when they privatise government-run institutions. That is what happened to mental hospitals all over Germany, and probably most other countries in the western world. And once they're private businesses, it's all about economics, which translates to firing just about anyone but a skeleton crew. I have spoken to people who are a few years older than me who have been to mental hospitals prior to privatisation, and they told me they had a jam-packed daily schedule of various therapies. After privatisation? Well, read the first part of this series (incidentally the first post in this blog, easy to find), and if you decide to go inpatient, prepare for eight to ten hours a day of smoking cigarettes, because thanks to economics, clinics are now very spartan when it comes to giving patients something to do.

And that is just the quantity. When it comes to quality, things get even more dire. There were two branches of therapies, one branch was therapies offered inside the ward by members of the staff, the other was therapies outside the wards in buildings specifically hosting these therapies, offered by staff wo were paid just for doing these therapy programs and nothing else.

Of the first branch, there were psychoeducation, metacognitive training (MCT) and integrated psychological training (IPT). The theory behind these is to educate you about your illness and thereby better help you manage it. In practice, and anyone who has been through any of those three can confirm it, all three are a complete waste of time. Psychoeducation tries to explain what is causing your illness (they don't really know) and how the medications they give you alleviate the symptoms, but you can tell half of it is guesswork because science just hasn't made it that far yet, and it doesn't help that they stretch material anyone of average intelligence can learn in 20 minutes over seven units that are one hour each. Metacognitive training attempts to teach you that your perception can deceive you if you don't know the whole story. Yeah, really. How that isn't obvious to everyone is beyond me, but again they stretch it out over weeks in hourly segments repeating the same idea over and over again. Finally, in IPT we played some word games and a board game, neither of which seemed to serve any purpose. I usually understand the intended purpose of therapies in principle even if I do not think they are very useful in practice, but IPT honestly just seemed like a way to kill time.

The second branch, by comparison, seems a little more like some sort of effort was put into giving the patients something to do other than sitting on a chair looking at spreadsheets. I did music therapy for two hourly sessions twice a week, which was a small handful of patients jamming on instruments with the music therapist. Fun, but not much more. Supposed to improve group interaction or something, but no one really listens to what anyone else is playing. I also did a drumming group twice weekly, which was a group of people with congas (African drums) sitting in a circle playing the same simple rhythms every single time. That one wasn't even fun.

The four main therapies you had to pick one from were painting, dance and theater, gardening, and animal husbandry. Painting was exactly how you imagine it, a bunch of people painting pictures. There were three different groups with different therapists, one of them more by-the-book painting by rules, the other more free-form, the third one I don't know. I was at the more free-form group two or three times and the atmosphere was very awkward, people were just doing their stuff and there didn't seem to be a point to any of it except keep people busy. Dance and theater I did not attend, but it was the most popular therapy in the clinic, so I heard a lot about it. Apparently they did half an hour of aerobics, then did improvisational theater. I do sort of see what they are aiming for with this, aerobics, like any physical exercise, has been known to be beneficial for people's mental health, and I guess with the theater they are supposed to train their interpersonal skills, or something? Seems like one of the more decent ideas there, but it wasn't compatible with my social anxiety so I never tried it out.

Gardening was what you imagine, taking care of the plant life around the huge clinic grounds. You even got paid for it, €1.50 an hour, €3 per unit - there were two units a day, but I only took the afternoon one because in the mornings I did music therapy and drumming. Since I was there in winter there was no actual gardening to be done, so I got to rake leaves every day. Fun. Guess this therapy is supposed to simulate a work environment. I just went because of the €3 and because the ward staff badgered me to pick a therapy (or else), and it seemed like the least stupid one. Animal husbandry was the same as gardening, except with animals rather than plants, also with the pay. I didn't take it because I thought it would be mostly scooping poop, but in hindsight I'd rather do that than rake leaves.

What the four have in common is that they are about as mentally challenging as an Adam Sandler movie, which is why I hated the two of the big ones I tried, the two minor ones, despite being music-related, and most certainly the ones offered at the ward. And none of them provide any therapeutic benefit for your illness, either, because they don't have anything to do with it. Those are the two big problems, and a third problem is that they only take up very little time of the day, so you have nothing to do for most of your time. But let me focus on the two big ones.

What really bugs me is that so many people I met during my stay at the schizophrenia ward were of above average intelligence, yet all of us had to pick what can only be appropriately called "idiot therapies." Could have done so much to challenge our brains, flex our cognitive muscles, but instead we were treated like we had Down's syndrome. The official explanation is that psychotic people are too easily stressed out by using their brains, but that's a load of crap. Being treated like toddlers was far more stressful. And why in blazes was there no group therapy where we could directly exchange experiences with our illnesses? Before privatisation every ward in every clinic everywhere in the country had a ton of that, and I have heard so much good about it, yet that seemed to be the first they got rid of when making their new private business more "economic." All we got were patronising toddler therapies that did nothing but kill time, and didn't even kill very much of it because we were still bored two-thirds of the day.

And no, you can't opt out. You have to take therapies in the morning and in the afternoon, or else. They never told me what they would do if I refused to do any of that nonsense, but considering the variety of ways they blackmailed me throughout my stay I figure I'd rather do my pointless music therapy and raking leaves than deal with whatever they would have decided to throw at me. If anyone who runs a private mental hospital ever reads this I can only respectfully request something that stimulates the brain a little, or something in which we can confront our illnesses, or both. Don't save money in areas that benefit your patients, that's like a steakhouse only offering bread because steaks are too expensive - hint: people go to steakhouses to have steak, that's what the business is about. You're a mental hospital, people want proper therapy. That is the service you are supposed to provide, so do it.

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